<%@ page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ taglib prefix="s" uri="/struts-tags" %>
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<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>友邦保险</title>
<link href="blitzer/jquery-ui-1.10.3.custom.css" rel="stylesheet" type="text/css" />
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<script language="javascript" src="js/jquery.validationEngine.js"></script>
<script language="javascript" src="js/jquery.validationEngine-zh_CN.js"></script>
<script language="javascript" src="js/group.js"></script>
<script language="javascript" src="js/citycodes.js"></script>
<script language="javascript">
var G_PID = "<s:property escape="false" value="gpinsu.GI_ID" />";
function ajaxSubmit()
{
	var isValidate = $('#form1').validationEngine('validate');
	if(!isValidate){
		alert("请正确输入");
		setTimeout("$('#form1').validationEngine('hide')",4000);
		return;
	}
	
	$.ajax
	({
		type:"POST",
		dataType:'json',
		cache:false,
		timeout:10000,
		async:false,
		url:"../json/groupForm2Json.action",
		data:$("#form1").serialize(),
		success:function(json)
		   {
			  if(json.success==true)
			  {		
				  alert("您的信息提交成功！我们会在一个工作日内安排营销员与您联系。谢谢！")
			  }
			  else
			  {
				  alert("提交没有成功:"+json.message);
			  }
			},
		error:function(arg1,arg2)
		   {
				alert("浏览器提交失败:" + arg1 + " "+arg2);
		   }
	});
	return false;
}//ajaxSubmit() end

</script>
<script language="javascript" src="js/form23.js"></script>
</head>
<body>
<div class="bg">
	<div class="top">
		<%@include file="common_left.jsp" %>
		
		<div class="right">
			<div style="height:330px; overflow: hidden;"></div>
			<div class="content_right">
		<form id="form1">
		<input type="hidden" name="GI_ID" id="GI_ID" value="<s:property escape="false" value="gpinsu.GI_ID" />" />
		<input type="hidden" name="from" value="form3" />
			<div style="width:400px; height:450px; margin-left:31px;">
				<div style="color:#d31145; font-size:14px; font-weight:bold; line-height:1.5; height:30px; overflow:hidden">
				* 请填写以下信息，我们将尽快安排营销员与您联系！
				</div>
				<table  class="mytable2" width="100%" style="margin-top:5px;" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td class="left_td"  width="98"><span class="redstar">*</span><span>联系人姓名</span></td>
    <td class="longputHolder"><input class="longput" name="FD_NAME" id="FD_NAME" type="text" /></td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>联系人称谓</span></td>
    <td class="longputHolder">
	<!--性别 start  -->
			   <table class="fm1_table" style="width:136px;  height:16px; font-size:12px; " width="136" border="0" cellspacing="0" cellpadding="0">
				  <tr>
				    <td valign="middle" align="left" style="height:16px; ">	
				        <input name="FD_SEX" id="FD_SEX1" class="validate[required]" type="radio" value="M" checked="checked"  style="margin-right:3px; vertical-align:-1px; " title="先生" /> 先生
						<input name="FD_SEX" id="FD_SEX2" class="validate[required]" type="radio" value="F" style="margin-right:3px; margin-left:15px; vertical-align:-1px;" title="女士"  />女士
					</td>
				  </tr>
				  </table>
			<!--性别 end  -->

    </td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>公司名称</span></td>
    <td class="longputHolder"><input class="validate[required] longput"  name="FD_COMPANY" id="FD_COMPANY" type="text" /></td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>公司业务</span></td>
    <td class="longputHolder">
    <select id="FD_SERVICE" name="FD_SERVICE"  class="validate[required] fm_select"  
					     style="width:262px; height:22px; font-size:12px; ">
<option value="">请选择</option>
<option value="一般职业" >一般职业</option>
<option value="一般买卖" >一般买卖</option>
<option value="IT业" >IT业</option>
<option value="建筑工程业" >建筑工程业</option>
<option value="制造加工维修业" >制造加工维修业</option>
<option value="医疗卫生保健业" >医疗卫生保健业</option>
<option value="文教机构" >文教机构</option>
<option value="服务业" >服务业</option>
<option value="公共事业" >公共事业</option>
<option value="其他" >其他</option>
		</select>
    </td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>公司地址</span></td>
    <td class="longputHolder">
<!--地址 start  -->
			   <table class="fm1_table" style="width:262px;" border="0" cellspacing="0" cellpadding="0">
				  <tr>
				    <td valign="middle" width="" align="left" style="height:22px;" >	
				      <select id="province_id" name="FD_PROVINCE"  class="validate[required] fm_select"  
					     style="width:87px; height:22px; font-size:12px;">
				      <option value="">请选择</option>
				    	</select>
				    	省
					</td>
					
				
				    <td height="25" valign="middle" width="" align="left">	
				       <select id="city_id"  name="FD_CITY" class="validate[required] fm_select"  
				            style="width:87px; height:22px; font-size:12px; margin-left:3px; ">
				      <option value="">请选择</option>
				    </select>
				   	 市
					</td>
					
				
				    <td height="25" valign="middle" width="" align="left" >	
				       <select id="dist_id"  name="FD_DISTRICT" class=" fm_select" 
						         style="width:67px; height:22px; font-size:12px; margin-left:3px; display:none ">
					      <option value="">请选择</option>
					    </select>
					</td>
				</tr>
		      </table>
			<!--地址 end  -->

    </td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>联系人手机</span></td>
    <td class="longputHolder"><input class="validate[required,custom[chinamobile]] longput" style="width:182px" name="FD_PHONE" id="FD_PHONE" type="text" />
    <span  id="sendDiv" ><a id="sendLink" href="#" ><img src="images/btnsms.jpg" ></img></a></span>
    
    	<div id="resendDiv" style="display:none" >
	   		<span style="color:#7e7777; font-size:12px;">如果180秒内没有收到校验短信，您可以点击&nbsp;</span><br /><a href="#" id='resendLink' style="color:#7E7777;font-size:14px;">重新获取验证码</a>
	   </div>
	   
    </td>
  </tr>
  
  <tr>
    <td class="left_td" ><span class="redstar">*</span><span>手机验证码</span></td>
    <td class="longputHolder"><input class="validate[required] longput" style="width:82px" name="FD_FREETEXT1" id="FD_FREETEXT1" type="text" />
    </td>
  </tr>
  
  <tr>
    <td class="left_td" ><span>公司电话</span></td>
    <td class="longputHolder"><input class="longput" name="FD_TEL" id="FD_TEL" type="text" /></td>
  </tr>
  
  <tr>
    <td class="left_td" ><input class="validate[required]" id="agree" name="agree" type="checkbox" value="Y"  style="margin-right:11px; margin-top:10px" /> </td>
    <td><div style="color:#D4003B; font-size:12px;line-height:1.6; height:55px; overflow:auto">
我了解本保费试算功能所产生的保费仅供参考，部分计算参数使用默认值（职业、社保情况等），并不代表实际投保信息。实际应付保费金额、具体保险责任及其保险合同的其他内容以保险合同条款为准。我愿意接受友邦保险雇员、保险营销员或经授权的合作方提供的与保险有关的后续客户服务和产品推荐。
</div></td>
  </tr>
  
  <tr>
    <td  colspan="2" class="submitHolder" valign="middle" align="center" >
  
	<a href="#" onclick="ajaxSubmit(); return false;" class="linkButton" style="float:left;margin-left:150px; margin-top:10px">提交信息</a>
	</td>
  </tr>
  
</table>

			</div>
			</form>
		</div>
		</div>
		<div class="clear"></div>
	</div>
</div>
<%@include file="common_ga.jsp" %>
</body>
</html>